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TAKING CLOZAPINE TO TREAT SCHIZOPHRENIA
Scientists still are puzzling over how clozapine and its cousins work. They contend that clozapine regulates the flow in the brain of molecules called neurotransmitters. They appear at the junctions of nerves. One nerve ending releases a neurotransmitter. It flows across the junction and causes an electrical discharge in the next nerve. Scientists have found a dozen neurotransmitters. Among those affected by clozapine are dopamine, serotonin, and norepinephrine.
Dr. Herbert Y. Meltzer, professor of psychiatry at Case Western Reserve University School of Medicine in Cleveland, explains how clozapine affects the flow of dopamine: It maintains a normal level of the neurotransmitter in areas of the brain that control emotion and motivation. With too little dopamine comes the disease’s flat emotional response; with too much dopamine come excitability and delusions.
Patients taking older drugs complain of feeling medicated, sleepy, and zombielike. Those taking clozapine report feeling more like their healthy selves. This reaction indicates that, with clozapine, they will have less need for institutionalization, avoiding the hospital “revolving door” situation.
Dr. Meltzer is investigating the possibility of using clozapine to treat schizophrenia from its onset.
Since 1989, clozapine has caused blood problems in several hundred patients, and a few have died. In addition, about 1 percent of patients suffer seizures if the dose is too strong for them. But most of the other side effects, including weight gain and excessive salivation, are infrequent and mild. And, unlike other schizophrenia drugs, clozapine does not trigger involuntary movements of the face and mouth – a condition that persists in some patients even after they stop taking those drugs.
Scientists say clozapine will lead to a better understanding of schizophrenia. They now theorize that the tendency to schizophrenia is inherited or caused by a prenatal viral infection.
Clozapine has raised the hopes of both doctors and patients. It may one day do for schizophrenia what penicillin did for infections.
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